Vascular Impotence Flashcards
Impotence causes
Hormonal Imbalance
Psychogenesis/Neurogenic dysfunction
Cavernosal venous leak
Arterial insufficiency
Penile anatomy
3 columns of spongy tissue encased by fibrous sheath
- 2 corpora cavernosa
- corpus spongiosum
Tunica albugenia: dense fibrous sheath encapsulates sinosoidal tissue and provides structure and support to the erect penis.
Corpus spongiosum surrounds urethra and remains in collapse state except during active urination. Forms glans penis at the end.
Corpus cavernosa: 2, expand with erection as blood fills.
Deep dorsal vein
Cavernosal artery
Blood supply to penis via
Bilateral penile arteries. Each a branch of the internal pudendal artery.
Penile artery branches
•dorsal artery
•cavernosal artery: travels in middle of corpus cavernosum.
Venous drainage of corpa cavernosum is vía small veins that perforate tunica albugenia that drain into deep dorsal vein.
When penis is erect, corpus cavernosa expands. The small veins are occluded by stretching of the tunica albugenia.
Indirect testing
Pt supine Plethysmographic waveform obtained Blood pressure obtained •BP cuff on prox shaft of penis •cuff sizes are 2.5*12.5cm or 2.5*9cm
Make sure ABI are normal first before doing PBI
Penile/Brachial index
Normal: > / = 0.75
Marginal: 0.65-0.74
Abnormal: <0.65 vascular impotence
Flaccid state
Veins open, arterioles constricted. Little blood in tissue.
Erect state
Arterioles open, blood fills tissue. Veins compressed.
Direct testing
Pt supine
7-10MHz
Cavernous arteries measured bilaterally
Trv AP meas
Sag PSV
Pre and post injection
Injects papaverine or prostaglandin at the lateral aspect of prox penis. To induce erection.
Asses cavernous arteries again. And deep dorsal vein.
Interpretation
High resistant flow pre injection
Lower resistant post injection.
PSV increase post injection.
Normal >30 cm/sec
Marginal 25-29cm/sec
Reduced <25 cm/sec
Deep dorsal vein. ( Flow vel should not increase post injection ):
Normal; < 3 cm/sec
Moderately increased 10-20cm/sec
Markedly increased > 20 cm/sec
Increase 4 cm/s could be venous leak which causes erectile dysfunction.
Injection complication-priapism
Persistent, painful erection lasting > 4 hours
Not caused by sexual stimulation
May be associated with sickle cell disease, leukemia, spinal cord lesion and of spinal cord trauma.
Varicocele.
Enlargement of veins of the spermatic cord
MC young men on left side
Scanning with patient standing and include valsalva maneuver.
Reversed flow is diagnostic of varicocele
Varicocele
The left gonadal vein empties into the left renal vein and had a higher risk of left sided varicocele formation.
Pampiniform plexus can dilate causing a varicocele. Varicoceles have been linked to infertility. Valsalva maneuver is used to increase varicocele vessel size and demonstrate reflux on Doppler.
